Indiana
Provider Communications

September 2019 Anthem Provider News - Indiana

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Title Category

Access requirements for behavioral health care services

Behavioral Health

AIM Specialty Health programs may require documentation

Medicaid

Anthem Commercial Risk Adjustment (CRA) Reporting Update: Risk Adjustment Data Validation (RADV) Audit happening now

Administrative

Anthem launches Sydney on September 1; new app offers better digital health care support to members

Administrative

Changes to prior authorization (PA) requirements

Medicare

Claim editing update for Excludes1 notes

Reimbursement Policies

Claims requiring additional documentation facility reimbursement policy update

Administrative

Clinical criteria and prior authorization updates for specialty pharmacy are available*

Pharmacy

Clinical Criteria updates

Medicare

Clinical Criteria updates

Medicaid

Clinical Guideline Updates -- September 2019*

Medical Policy & Clinical Guidelines

Coming soon: Electronic attachments

Medicare

Coming soon: Electronic attachments

Medicaid

Customizations to the 23rd edition of the MCG Care Guidelines

Medicare

Medicare News -- September 2019

Medicare

New Reimbursement Policies: Maternity Services and Multiple Delivery - Professional*

Reimbursement Policies

New Reimbursement Policy: Intensity Modulated Radiation Therapy Planning and Delivery - Professional*

Reimbursement Policies

Notice of Changes to Prior Authorization Requirements -- September 2019

New prior authorization requirement for providers and/or Material Changes to Contract may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
Administrative

PCP after-hours access requirements

Administrative

Pharmacy benefit manager change to IngenioRx

Medicare

Prior authorization changes

Medicaid

Prior authorization requirements for hyperbaric oxygen and supervision of hyperbaric oxygen therapy

Medicaid

Provider Transparency Update

Administrative

Reimbursement Policy Update: Professional Anesthesia Services

Medicaid

Reminder: Changes to timely filing requirements coming in October

Administrative

Start using Anthem’s electronic portals now for prior authorization requests

Administrative
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